【摘要】 目的:应用改进治疗方法治疗先天性髋脱位,预防术后关节僵硬的发生。方法:①选择1987-01/2002-12郑州市骨科医院小儿骨科手术治疗先天性髋脱位患儿351例(412髋),男65例,女286例。②应用传统治疗方法239例(277髋),应用改进治疗方法112例[(135髋),手术方法的改进:术前充分牵引;股骨近端前倾角的矫正;髋臼截骨的方法和常规步骤一样。但截骨后向下、外压以后,两截骨端之间的距离,也就是植骨块的高度,用作者设计的计算方法,在术前估算得出,术中可快速准确完成截骨]。患儿监护人对治疗方案知情同意。③术后早期被动结合主动功能锻炼,麻醉下关节授动。疗效评定标准:髋关节功能评定15分,X射线平片检查评定15分,优:30～26分,良:25～21分,可:20～16分,差:<15分。所有患者均参加随访,随访时间平均5年,观察患者髋关节功能及X射线平片检查结果。结果:先天性髋关节脱位患儿351例均进入结果分析。应用传统治疗方法治疗的优良率达85.6%,并发关节僵硬53髋(19.1%)。应用改进治疗方法治疗的优良率达94.8%,并发关节僵硬11髋(8.2%)。关节僵硬发生率由19.1%降至8.2%,差异明显(P<0.01)。结论:改良股骨、髋臼截骨术式并术后功能锻炼,对先天性髋脱位患儿术后关节僵硬及髋关节功能恢复有较好的改善作用。更多还原

【Abstract】 AIM: To treat congenital dislocation of hip and prevent the occurrence of postoperative ankylosis by the modified therapeutic methods. METHODS: From January 1987 to December 2002, 351 children (65 boys and 286 girls, 412 hips) with congenital dislocation of hip were treated with operative reduction in the Department of Pediatric Orthopaedics, Zhengzhou Orthopaedic Hospital. ② Among them, 239 patients (277 hips) were treated with traditional treatment, 112 patients (135 hips) were treated with modified treatment. The modified treatment included: enough traction of the leg before the operation, correction of proximal femoral anteversion angle, modified osteotomy of and acetabulum was the same as the routine one. The distance between two osteotomized bones (the height of grafted bone) after downward and outward presses was estimated by using the calculative method designed by the author, which was benefit for that the osteotomy could complete rapidly and accurately. The children’s guardians all know the treatment and agreed. ③ Postoperative passive plus active functional exercise were performed under anesthesia. Evaluation criteria: 15 points for the functional evaluation of coax, and 15 points for the examination of X-ray plain fil 30-26 as excellent, 25-21 as good, 20-16 as moderate, and < 15 as bad. All the patients were followed up for 5 years averagely, the function of coax and results of X-ray plain fil were observed. RESULTS: All the 351 children with congenital dislocation of hip were involved in the analysis of results. In the patients treated with the traditional methods, the excellent and good rate reached 85.6%, and 53 hips (19.1%) were complicated with ankylosis. In the patients treated with the modified methods, the excellent and good rate reached 94.8%, and 11 hips (8.2%) were complicated with ankylosis. The incidence rate of ankylosis reduced obviously from 19.1% to 8.2% (P < 0.01). CONCLUSION: The modified osteotomy of femur and acetabulum together with postoperative functional exercise can better ameliorate the postoperative ankylosis and recovery of the coax function in children with of congenital dislocation of hip.更多还原